Article Text
Abstract
Objective To describe patterns of HIV infection among stable sexual partnerships across sub-Saharan Africa (SSA).
Methods The authors defined measures of HIV discordancy and conducted a comprehensive quantitative assessment of discordancy among stable partnerships in 20 countries in SSA through an analysis of the Demographic and Health Survey data.
Results HIV prevalence explained at least 50% of the variation in HIV discordancy, with two distinct patterns of discordancy emerging based on HIV prevalence being roughly smaller or larger than 10%. In low-prevalence countries, approximately 75% of partnerships affected by HIV are discordant, while only about half of these are discordant in high-prevalence countries. Out of each 10 HIV infected persons, two to five are engaged in discordant partnerships in low-prevalence countries compared with one to three in high-prevalence countries. Among every 100 partnerships in the population, one to nine are affected by HIV and zero to six are discordant in low-prevalence countries compared with 16–45 and 9–17, respectively, in high-prevalence countries. Finally, zero to four of every 100 sexually active adults are engaged in a discordant partnership in low-prevalence countries compared with six to eight in high-prevalence countries.
Conclusions In high-prevalence countries, a large fraction of stable partnerships were affected by HIV and half were discordant, whereas in low-prevalence countries, fewer stable partnerships were affected by HIV but a higher proportion of them were discordant. The findings provide a global view of HIV infection among stable partnerships in SSA but imply complex considerations for rolling out prevention interventions targeting discordant partnerships.
- HIV
- demographic and health survey
- discordancy
- sexual partnerships
- sub-Saharan Africa
- epidemiology
- behavioural intervention
- AIDS
- sexual behaviour
- epidemiology
- epidemiology
- HSV-2
- epidemiology (general)
- homosexuality
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Footnotes
Funding Qatar National Research Fund (QNRF) (NPRP 08-068-3-024), the Biostatistics, Epidemiology, and Biomathematics Research Core at the Weill Cornell Medical College in Qatar (WCMC-Q), The Wellcome Trust, and the National Institutes of Health (R01 AI083034).
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.